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Violence Treated as a Disease by Loyola Trauma Experts

MAYWOOD, Ill. - The Windy City is now the Wounded City, thanks to a spate of carnage that has Chicago ranked top nationally in violence for several weeks in a row. Violent crime costs Chicago about $5.3 billion a year, according to a new report from the Center for American Progress. Homicides have risen about 35 percent compared with the same period in 2011.

“As a Level 1 trauma center, Loyola is used to caring for the worst of the worst, but things have escalated to the point where the worst now is often lying dead in the streets,” said Thomas Esposito, MD, MPH, chief of the Division of Trauma, Surgical Critical Care and Burns in the Department of Surgery at Loyola University Medical Center. “It’s not just the weather that is heating up. This is a public health problem."

Ninety-two people were shot, 14 fatally, during the consecutive weekends of June 9-10 and June 16-17 in Chicago, in the third largest city in the U.S. At least 240 people have been shot dead in Chicago since January. In Afghanistan, 144 U.S. troops were killed while on duty during that time. Violence in New York and Los Angeles, however, is reportedly down.

“It’s drugs, it’s gangs and it’s guns all in a close, urban environment,” said Mark Cichon, DO, FACEP, FACOEP, division director, Emergency Medical Services, and professor of Surgery and Emergency Medicine at Loyola. “But trauma and burn patients from Downstate Illinois, Wisconsin, Michigan and Indiana are regularly flown in to Loyola for care and I can tell you a rise in violence is everywhere.” In 2011, the Loyola Level 1 trauma center received 123 gun-related cases; 21 were fatal.

Violence is a Disease

“Just like cancer, violence is a disease and it has to be treated through constant education, prevention, treatment and rehabilitation,” said Hieu Ton-That, MD, assistant professor of Surgery and a trauma surgeon at Loyola. Since 2008, Loyola has partnered with CeaseFire, a national, non-government program dedicated to violence prevention. “CeaseFire works! Their people are incredibly connected to the community we serve and communicate effectively to help end violence,” said Ton-That. “In cases of violence, Loyola chaplains connect with CeaseFire and they put the right members in contact with everyone involved to try to interrupt the cycle of violence."

Voted one of the top 100 Non-Government Organizations, CeaseFire uses proven public health techniques through a three-prong approach:

Identification & detection

Interruption, intervention, & risk reduction

Changing behavior and norms

A popular slogan for gun proponents is “Guns don’t kill people, people kill people.” Esposito added the qualifier, ”But it’s much more effective if you use a gun!"

“There are all kinds of dangerous weapons, including knives and even bottles, but guns are the most lethal,” he said. In fact, gun-related injuries are 15 times more likely to be fatal than knife wounds. Recent national data reveal that 70 percent of homicides involve a firearm.

“Every day in America, 65 people are killed by handguns. One child is killed each day by a handgun,” he said. Esposito also pointed out that there are now more wounds per body, more tissue destruction, more deaths and death at the scene of the crime are up threefold. Even the engineering and technology of guns, right down to the bullets, contributes to the rise in fatalities, Esposito said.

“The controversy in the United States focuses on the gun itself being a bad thing, and a ban on guns being the only solution,” Esposito said. He said this is a narrow view of the problem. For example, despite disagreeing on many issues with the National Rifle Association (NRA), he said, “The NRA actually has one of the best education programs I have seen that focuses on respecting guns, using them safely and responsibly."

“Gun violence and firearm injuries must be approached as a disease that is preventable, diagnosable, treatable and survivable,” Esposito said. He pointed out that the Centers for Disease Control and Prevention (CDC) sees this in the same light. The CDC views this as a public health issue that has become an epidemic, much the same as polio or West Nile virus. He said that is why the CDC offers numerous potential countermeasures to curb gun violence besides just gun control laws. Generally, these involve strategies related to technology, enactment and enforcement of laws, economic incentives and disincentives, and finally, education. Esposito mentioned some of these strategies, including:

Taxes on the purchase of guns/ammunition

Promoting use of trigger locks and safe storage

Bulletproof vests and glass

Gun buyback programs

Providing alternative conflict resolution education in schools

Setting and enforcing curfews

Creating safe havens where no gang activity is allowed by mutual agreement

Support of trauma centers and trauma systems

Esposito, who also has a master’s degree in public health, said, “The more, and varied, countermeasures that are implemented, the better the chances of successfully reducing and controlling the problem."

The Center for American Progress’ report also set a price of $4.2 billion for pain and suffering brought on by violence in Chicago with $1.1 billion attributed to direct costs ranging from medical expenses to lost income of victims and criminals who are incarcerated. Esposito agreed that the negative effect of violence is widespread. “Violence drives up the cost of medical care, police protection, the judicial system, to name just a few. The costs are simply astronomical,” he said.

“Each of us is a respected and powerful force in our communities and each of us can make a difference in violence prevention and control,” he said. “Do we want to continue to spend our money on violence? I don’t."

Loyola University Health System (LUHS) is a member of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and more than 30 primary and specialty care facilities in Cook, Will and DuPage counties. The medical center campus is conveniently located in Maywood, 13 miles west of the Chicago Loop and 8 miles east of Oak Brook, Ill. The heart of the medical center campus is a 559-licensed-bed hospital that houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children's Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as the LUC Stritch School of Medicine, the LUC Marcella Niehoff School of Nursing and the Loyola Center for Fitness. Loyola's Gottlieb campus in Melrose Park includes the 255-licensed-bed community hospital, the Professional Office Building housing 150 private practice clinics, the Adult Day Care, the Gottlieb Center for Fitness, Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.